The Health Committee has voiced concerns over plans to pass control of Public Health budgets to Local Government in a new Public Health report. Launching the report, Health Select Committee Chair Rt Hon Stephen Dorrell MP said "Public Health England (PHE) must be visibly and operationally independent of Ministers. It must demonstrate that it is able to, and regularly does, speak 'truth unto power'."
Dorrell also said the Committee remained "unconvinced that the new Responsibility Deal will, by itself, resolve major issues such as obesity and alcohol abuse. The Government must set out clearly how progress will be monitored, and when tougher action will be taken if ‘nudging’ does not work." A Lords Select Committee earlier the year said the 'nudge' approach alone is not enough.
Local Government is due to take over responsibility for work which includes drug and alcohol and lifestyle programmes under the Public Health reforms. This means budgets for drug and alcohol treatment and prevention will fall under the governance of Local Government from 2013 alongside the transfer of Directors of Public Health, currently employed by Primary Care Trusts (PCTs). Health Secretary Andrew Lansley has stated Public Health budgets will be protected, indicating around £4bn will be ring-fenced for Public Health nationally.
However the Health Committee, a cross-party group of MPs, worry that Local Government budget cuts might compromise the "protected position" of such monies. Local authorities face a reduction in funding from £29.7bn to £24.2bn by 2014, a 26% reduction accounting for inflation. The Health Committee fear scenarios where schemes are "re-badged" to take advantage of the Public Health ring-fenced monies. One BBC report suggested councils might 'play the system' in ways such as using Public Health budgets on road repairs and potholes since they can impact on hospital admissions.
MPs have called for assurances that Directors of Public Health retain some of their powers to ensure the security of ring-fenced money. Inevitably, it is argued, it is the most disadvantaged communities who will suffer if disinvestment takes place. Whilst the the Department of Health (DH) has committed to narrowing the gap in health inequalities, disinvestment in local treatment and support services will surely impact negatively on health outcomes. Alcohol services are already under-funded with organisations such as Alcohol Concern regularly calling for further investment.
The DH have stated that the new ring-fenced budget is intended to pay for new Public Health functions, not currently existing schemes. Concerns over possible disinvestment are not shared by the Local Government Association (LGA) who assert that they are best placed to decide how Public Health monies should be spent locally, and reassure that "Public Health is at the heart of what councils do".
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